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Comment by lovich | Hacker News Reader

The conservative viewpoint is that the government can never do things as well as companies can, so they like to not provide services.

The reason companies provide healthcare at all is an artifact from WWII when the tax rate was high enough that offering more salary was not enough to attract the limited workers left, so companies started offering other perks that were untaxed. Since the US Constitution being set up in a way as to encourage deadlock if there is not a large majority of agreement, were stuck in a deadlock on moving this forward to a government operated endeavor, and wont do anything to remove it from an employer offered benefit.

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An addendum to this is that the government forced the companies to do this because the feds passed the insane 1942 Stabilization Act putting limits on wage hike capabilities of firms.

The problem is that we have good economists who say: here are the facts and history of what your choices will do and bad economists who say: if you have x, y, z, and the planets of Saturn and Uranus in alignment, you may be able to affect the economy to the way you wish despite all of the historical evidence to the contrary. The bad economists are hired into administrations to justify politically expedient proposals.

I mean the US was in a fully mobilized war at that point. I don't think the government was looking at long term consequences but at winning the war and surviving

The market theory breaks down with healthcare, which does not operate in a free market or with adequate competition/price visibility. Furthermore the entire concept of "price" falls apart when talking about the fundamentally priceless nature of human life.

The conservative viewpoint is woefully ignorant of the reality of healthcare and the success of socialized medicine almost everywhere it has been implemented, or at least superior quality and lower price to that available to the prototypical American citizen.

I wish the myth that "the markets will provide the optimal solution" will die when talking about healthcare. It hasn't, it can't, and it won't.

I wish more people understood the limitations of markets (just as I wish more people understood the power of markets). Markets only work well with with price/quality transparency, enough competition, substitutability... everything that healthcare in America lacks.

As far as market mechanics in healthcare, Singapore has the closest thing to market mechanics in healthcare (albeit heavily subsidized and regulated): https://www.vox.com/policy-and-politics/2017/4/25/15356118/s...

> What Singapore shows is that unusual fusions of conservative and liberal ideas in health care really are possible. Singapore is a place where the government acts to keep costs low and then uses those low costs to make a market-driven insurance system possible.

> The market theory breaks down with healthcare, which does not operate in a free market or with adequate competition/price visibility.

This is a problem that could in principle be solved using price transparency. Most medical procedures are scheduled ahead of time. Emergency services are a small percentage of overall healthcare costs and there is no need to treat everything else the same way.

> Furthermore the entire concept of "price" falls apart when talking about the fundamentally priceless nature of human life.

The high value of the product doesn't break anything as long as there is adequate competition. You die without water but that doesn't mean Evian can charge a million dollars for a bottle.

> The conservative viewpoint is woefully ignorant of the reality of healthcare and the success of socialized medicine almost everywhere it has been implemented, or at least superior quality and lower price to that available to the prototypical American citizen.

Most socialized systems around the world are piggybacking on all the R&D done in the US and paid for by the huge US market paying high prices. We obviously can't do the same thing to ourselves to get lower prices. And outcomes in the US for people who actually have health insurance (i.e. the large majority) are better than they are almost anywhere else in the world.

> Most medical procedures are scheduled ahead of time.

Does that really matter when the procedure is non-optional?

It's not just price that matters, but also the quality of the provided healthcare, and you're forcing somebody to make a stressful decision when they're already impaired by whatever health issue makes that procedure necessary.

Basically, most health-related decisions are made under at least some level of duress, which makes all "free choice" based reasoning at least somewhat suspect.

> Does that really matter when the procedure is non-optional?

Of course it does. If you have time to shop around then you can choose a provider that costs less, and if we had real price transparency it would allow people do to this, which would require providers to compete on price and that would lower costs.

> It's not just price that matters, but also the quality of the provided healthcare, and you're forcing somebody to make a stressful decision when they're already impaired by whatever health issue makes that procedure necessary.

Quality is ensured by medical licensing. If there are five providers that have all met the licensing requirements, maybe some of them are still better than others, but how do you know that even now? It's a completely independent problem. You still need some way to figure that out regardless of whether there is transparent pricing; or you just have to trust the licensing process to ensure a minimum level of quality.

> Basically, most health-related decisions are made under at least some level of duress, which makes all "free choice" based reasoning at least somewhat suspect.

How is this any different than buying food? You have to buy it but that doesn't mean you can't have a market.

The difference with buying food is that that is a recurring item where you as a buyer can learn over time about relative prices and quality and adjust your behavior accordingly.

Medical procedures are ideally one-time affairs.

> Medical procedures are ideally one-time affairs.

Sure, but so are a lot of other things we have markets for. Ideally you don't have to buy a car more than once every five or ten years, by which point the models on the market have been redesigned and your experience may not be relevant. You also have no basis for comparison; if you buy a worse car, how do you know the competition is any better?

The answer is that you rely on the experiences of other people and independent reviewers, or the advice of professionals. If you ask your doctor which provider is better, they may have some information about that -- either be able to tell you they're all the same so choose the cheapest one, or they're all good except this one which should be avoided, so choose the cheapest from the remainder etc.

How is it fundamentally priceless if the law and insurance companies agree on close to standard values for compensation

That's assuming the prices they agree on are optimal, which implies they have all the right incentives.

They could be paying too much in some cases (and then healthcare costs more than it should and some people can't afford it and die), or not enough in others (and then we get less medical R&D and more people die).

It's not an easy problem. And we can't just hand wave it to "have the government do it" as if they have some magic price-finding method that isn't susceptible to principal-agent problems or bureaucratic inefficiency or regulatory capture.

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